Archive for the ‘Lyme’ Category

Disseminated Lyme Disease More Likely In Those With Weakened Immune System

https://danielcameronmd.com/impaired-immunity-increases-risk-of-disseminated-lyme-disease/

DISSEMINATED LYME DISEASE MORE LIKELY IN THOSE WITH WEAKENED IMMUNE SYSTEM

Sick woman sitting on couch with disseminated Lyme disease

Individuals with a weakened immune system are more susceptible to developing infections, such as COVID-19. A review study has also found that people with compromised immune systems are at a greater risk of developing disseminated Lyme disease. The authors of “Erythema Migrans: Course and Outcome in Patients Treated With Rituximab” investigated patients diagnosed with Lyme disease, who were also taking Rituximab, a medication known to impair immunity. [1]

By

The small study examined the risk of developing disseminated Lyme disease for people with weakened immune systems. Researchers enrolled 7 patients with an EM (erythema migrans) rash who were diagnosed with Lyme disease. All of the patients were receiving Rituximab for another underlying medical condition. Out of the 7 patients, 4 were also being treated with additional immunosuppressant drugs (e.g., corticosteroids, methotrexate, and bortezomid).

“Rituximab is the anti-CD20 monoclonal antibody that influences B cells and consequently impairs secretion of antibodies, antigen presentation, and secretion of cytokines,” writes Maraspin and colleagues.

Rituximab is used for non-Hodgkin lymphoma, rheumatoid arthritis, chronic lymphocytic leukemia, and granulomatosis with polyangiitis (Wegener granulomatosis).

Signs of disseminated Lyme disease

According to the authors, 43% of the patients treated with Rituximab showed unusually high signs of disseminated Lyme disease, compared to 8% of immunocompetent individuals.

The isolation rates of Borrelia from the blood before antibiotic treatment were also unusually high (40%) when compared with immunocompetent patients (<2%).

“Impaired immunity might be an explanation for the complicated course of LB (signs of disseminated LB or unfavorable outcome after antibiotic treatment) present in 57% of our patients, but rarely seen in immunocompetent adult patients with EM, of whom only about 8% have disseminated disease and approximately 10% have treatment failure, most often the presence of LB-associated symptoms,” the authors write.

In their study, 3 of the patients with multiple EM rashes were treated with intravenous antibiotics. The remaining individuals received oral antibiotics.

READ MORE: Lyme disease manifests as autoimmune disorder

One patient, a 65-year-old woman, failed initial treatment. “Her skin lesion persisted for >2 months after the start of treatment with doxycycline,” explains Maraspin. “However, it disappeared after retreatment with amoxicillin and the subsequent clinical course was uneventful.”

At their 1-year follow-up, none of the patients had any objective (or physical) signs of Lyme disease. However, the authors did not mention the presence of other symptoms, such as fatigue, pain, and cognitive problems.

Retreatment for immunocompromised patients 

Meanwhile, a study by Maraspin and colleagues reports that 25% of Lyme disease patients who had received immunosuppressive drugs, such as adalimumab, infliximab, etanercept, golimumab, failed treatment for Lyme disease. Three of the four patients required retreatment.

Patients with weakened immune systems were also more likely (18.8%) to develop signs of disseminated Lyme disease when compared to Lyme disease patients who were immunocompetent.

Editors note: The increased chance of disseminated Lyme disease in patients with impaired immunity needs further study. I would also address the risk of treatment failures on other outcomes including fatigue, pain, and cognitive problems.

Related Articles:

People re-infected with Lyme disease may develop strain-specific immunity 

Can Lyme disease trigger an autoimmune disease?

Persistent Lyme infection or inflammatory immune response?

References:
  1. Maraspin, V., et al. (2019). “Erythema Migrans: Course and Outcome in Patients Treated With Rituximab.” Open Forum Infect Dis 6(7): ofz292.

__________________

**Comment**

The one question that hasn’t been answered fully is what exactly is causing this impaired immunity?  While many would love to solely blame the patient’s immune system, many have yet to consider the interplay between how over time these pathogens directly impact the immune system negatively.  From experience I can state that most Lyme/MSIDS patients, prior to becoming infected, are some of the healthiest people I know.  They eat right, exercise, love the outdoors, and take their health seriously.

Until the answer to impaired immunity is determined (and it may vary from patient to patient), patients will not be treated appropriately.

For more:  https://madisonarealymesupportgroup.com/2020/03/09/the-long-term-persistence-of-borrelia-burgdorferi-antigens-dna-in-the-tissues-of-lyme-disease-patient/

Category:

Lyme, research, Treatment

How Lyme and Hidden Infections Sabotage Our Clinical Outcomes

This article, although a year old, has some great insights.

https://www.townsendletter.com/article/432-how-lyme-and-hidden-infections-sabotage-our-clinical-outcomes/

How Lyme and Hidden Infections Sabotage Our Clinical Outcomes

By Jason Bachewich, ND

What if I told you that as a clinician, you were potentially misdiagnosing a large percentage of your autoimmune patients?  What if the arthritis, Alzheimer’s, cancer, or Grave’s disease was actually caused by an infection?   The research is starting to show that perhaps our bodies are not flawed or simply have bad luck but rather sabotaged by chronic and hidden infections.  Our treatment plans would be different, and our outcomes more positive.  This is the beginning of a whole new understanding of chronic disease, and the potential is hugely exciting.

Lyme disease has been gaining a lot of attention in the media lately.   Doctors are becoming more aware of the symptoms, but why just look at Lyme disease?  There are multiple bacterial, viral, and other parasitic infections that can sabotage our clinical outcomes and have been ignored or assumed to be benign. This article is going to help you to identify those key symptoms to look for, how to test for the infections, and familiarize you with the most common hidden infections that we are not taught about in medical school. (See link for article)

_____________________

**Comment**

Time for the one germ one drug paradigm to die.  Patients present with complex clinical pictures that can not be explained away simply, but demand astute observation and lengthy medical histories.  It is not uncommon for patients to have multiple things going on simultaneously.

For more:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

Excerpt:

For the first time, Garg et al. show a 85% probability for multiple infectionsincluding not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.

I’m thankful they included Bartonella as that one is often omitted but definitely a player.  I’m also thankful for the mention of viruses as they too are in the mix.  The mention of the persister form must be recognized as well as many out there deny its existence.

Key Quote:  “Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

Many patients also struggle with mold and mast cell issues:  https://madisonarealymesupportgroup.com/2019/10/25/dealing-with-lyme-disease-and-mold-illness-at-the-same-time/

https://madisonarealymesupportgroup.com/2018/12/29/mcas-triggers-symptoms-how-to-cope/

https://madisonarealymesupportgroup.com/2018/03/13/mcas-lyme-msids/

https://madisonarealymesupportgroup.com/2019/05/08/9-proven-treatments-for-mast-cell-activation-syndrome-plus-a-surprising-new-comer/

For more:  https://madisonarealymesupportgroup.com/category/lyme-disease-treatment/

 

 

Category:

Lyme, Mast Cell Activation Syndrome (MCAS), Mold

New Treatments For Lyme Disease On The Horizon?

https://danielcameronmd.com/new-treatments-for-lyme-disease/

NEW TREATMENTS FOR LYME DISEASE ON THE HORIZON?

Patients with Lyme disease are typically treated with a standard antibiotic, which may include doxycycline, amoxicillin, or cefuroxime, for a 2 to 4 week period. However, studies have shown that between 36-63% of treated patients continue to suffer with persistent symptoms. [1]

By

Study findings suggest that current Lyme disease treatment may not eliminate the Borrelia burgdorferi infection or the immune system may fail to clear the infection or bacterial debris, resulting in ongoing symptoms. In the past few years, several new treatments for Lyme disease have been investigated in the laboratory or made available to patients in an effort to address chronic symptoms.

Although still in the early stages, two new treatments for Lyme disease seem to show promising results. Published case reports describe the effectiveness of dapsone, an antibiotic typically used to treat skin conditions and disulfiram, frequently prescribed for alcohol abuse.

Dapsone

Horowitz et al. reviewed data from 200 patients to evaluate “the efficacy of dapsone combined with other antibiotics and agents that disrupt biofilms for the treatment of chronic Lyme disease/post-treatment Lyme disease syndrome (PTLDS).” [2]

They found that it “decreased eight major Lyme symptoms severity and improved treatment outcomes among patients with chronic Lyme disease/PTLDS and associated co-infections.”

This new treatment for Lyme disease was not without side effects, however. Horowitz reports, 46 of the 200 patients stopped treatment due to an ‘adverse reaction.’ The adverse effects were not specified.

When used for other conditions, dapsone’s side effects have included haemolysis, agranulocytosis, photosensitivity, skin eruptions, neuropathy, and toxic or cholestatic hepatitis. [3]

Disulfiram

Disulfiram, a medication used to treat alcohol abuse, may be one of the new treatments for Lyme disease in the near future. Two small studies have shown positive results.

Dr. Kenneth Liegner reports that 3 patients, who required extensive, ongoing antibiotic treatment due to neurological Lyme disease and Babesia, “were able to discontinue treatment and remain clinically well for periods of observation of 6–23 months following the completion of a finite course of treatment solely with disulfiram.” [4]

One patient did relapse at 6 months and was re-treated with disulfiram.

READ MORE: 6 reasons for delayed treatment of Lyme disease

The results from another group of 30 patients who received disulfiram were described by Liegner during the 2019 International Lyme and Associated Diseases Society (ILADS) annual conference. “Results have been impressive, and disulfiram use, with careful supervision, has been relatively safe.”

“It will remain to be seen whether disulfiram has a role in acute or early Lyme disease or babesiosis,” Liegner adds.

Furthermore, “Any role for disulfiram in children, with their incompletely matured nervous systems, remains to be determined and should be approached with caution, as there is little experience with its use in children.”

None of Liegner’s three patients stopped treatment with disulfiram. One patient had a temporary psychiatric hospitalization, and a second stopped after a syncope event that led to a concussion that required hospitalization. And according to Liegner, the risk of adverse events was even lower in the study involving 30 patients.

Disulfiram’s side effects, when prescribed for other conditions, have included “encephalopathy, convulsion, cranial and peripheral neuropathy, toxic optic neuropathy, irreversible injury to the basal ganglia with permanent neurological deficits, hypertension, and drug-induced psychosis, presumably due to the inhibition of dopamine beta-hydroxylase,” writes Liegner.

Another study investigating disulfiram as one of the new treatments for Lyme disease and co-infections was launched in 2019 by Dr. Brian Fallon, from the Lyme and Tick-Borne Diseases Research Center at Columbia University.

Azlocillin

A study by Stanford Medicine suggests that the antibiotic azlocillin “completely kills off the disease-causing bacteria Borrelia burgdorferi at the onset of the illness.” In addition, the authors say, azlocillin “could be effective for treating [Lyme disease] patients infected with drug-tolerant bacteria that may cause lingering symptoms.” [5]

Researchers tested azlocillin in mice infected with Lyme disease at 7-day, 14-day and 21-day intervals and found that it eliminated the infection. Additionally, in lab dishes, the azlocillin killed drug-tolerant forms of B. burgdorferi, “indicating that it may work as a therapy for lingering symptoms of Lyme disease,” according to the Stanford team.

Azlocillin has not yet been prescribed or studied in Lyme disease patients.

Azlocillin adverse events for other indications have included hypersensitivity reactions, hypocalaemia, hepatotoxicity, diarrhea, and leukopenia. [6] There are also costs and risks associated with the need to administer azlocillin intravenously.

Combination: daptomycin, doxycycline, and ceftriaxone

Researchers from Johns Hopkins School of Public Health found that a combination of antibiotics – daptomycin, doxycycline, and ceftriaxone − eradicated the slow-growing variant form (persisters) of the Lyme bacteria in a mouse model. Scientists believe persisters may be responsible for the chronic symptoms that some Lyme disease patients experience.

“There is a lot of excitement in the field because we now have not only a plausible explanation but also a potential solution for patients who suffer from persistent Lyme disease symptoms despite standard single-antibiotic treatment,” says Ying Zhang, MD, Ph.D., senior author on the study.

Zhang and his team hope to test the drug combination in people with persistent Lyme disease

Daptomycin has not yet been prescribed to Lyme disease patients, and adverse effects, for other conditions, have included myopathy/rhabdomyolysis, eosinophilic pneumonia, and anaphylactic hypersensitivity reactions. [8]

There are also costs and risks associated with the need to administer daptomycin intravenously.

Editor’s note: I am encouraged by all the research seeking to identify new treatments for Lyme disease and remain hopeful that we will develop research designs to evaluate the value of these and other treatments for tick-borne diseases.

Related Articles:

Will late stage Lyme disease treatment include azlocillin?
Is prolonged treatment for Lyme disease the new norm?
Persister cells survive attacks by antibiotics and may contribute to chronic illness in Lyme disease patients

References:
  1. Adrion ER, Aucott J, Lemke KW, Weiner JP (2015) Health Care Costs, Utilization and Patterns of Care following Lyme Disease. PLOS ONE 10(2): e0116767. https://doi.org/10.1371/journal.pone.0116767
  2. Horowitz RI, Freeman PR. Precision medicine: retrospective chart review and data analysis of 200 patients on dapsone combination therapy for chronic Lyme disease/post-treatment Lyme disease syndrome: part 1. Int J Gen Med. 2019;12:101-119.
  3. Wozel G, Blasum C. Dapsone in dermatology and beyond. Arch Dermatol Res. 2014;306(2):103-124.
  4. Liegner KB. Disulfiram (Tetraethylthiuram Disulfide) in the Treatment of Lyme Disease and Babesiosis: Report of Experience in Three Cases. Antibiotics (Basel). 2019;8(2).
  5. Pothineni VR, Potula HSK, Ambati A, et al. Azlocillin can be the potential drug candidate against drug-tolerant Borrelia burgdorferi sensu stricto JLB31. Sci Rep. 2020;10(1):3798.
  6. Parry MF. The tolerance and safety of azlocillin. J Antimicrob Chemother. 1983;11 Suppl B:223-228.
  7. Feng J, Li T, Yee R, et al. Stationary phase persister/biofilm microcolony of Borrelia burgdorferi causes more severe disease in a mouse model of Lyme arthritis: implications for understanding persistence, Post-treatment Lyme Disease Syndrome (PTLDS), and treatment failure. Discov Med. 2019;27(148):125-138.
  8. Patel S, Saw S. Daptomycin. In: StatPearls. Treasure Island (FL)2020.

_____________________

**Comment**

This type of work has been a long time coming but is desperately needed.  I’ve posted on all of these treatments before here:

Dapsone and PZA (mycobacterium drugs):

Azlocillin (antibiotic):

Ceftriaxone (antibiotic):

Disulfiram (old drug used for alcoholism – also called Antabuse):  

My husband and I both tried Disulfiram.  He did fine on it while I suffered with psychosis:  https://madisonarealymesupportgroup.com/2019/10/15/disulfiram-psychosis-update/.  Others have suffered the same side-effect; however, work with your doctor to mitigate risks as much as possible by titrating up slowly and only using the dose required for you to achieve benefit.  For some, this dosage is quite small.

I’m still glad I tried it and would recommend it; however, if you are a single patient, make sure you have a support system in place and people checking in on you regularly.  I had no idea I was going mad.  Thankfully my family picked up on it.  I spent a week in the hospital with the most severe toxic reaction to disulfiram the UW hospital has ever seen.  Buyer beware.

Lyme Disease Treatment:

Effective Lyme treatment is typically overlapping in nature to address all forms of borrelia as well whatever coinfections are present. Each case is extremely individual based upon what pathogens are at play as well as nutritional, hormonal, mineral, environmental, and immune status challenges.

Lyme/MSIDS weakens the body in many areas.  Supporting those areas is key and takes savvy in hunting down and addressing.  Partner with your practitioner by learning as much as you can so you can bring ideas to the table.

Addressing this is a partnership and will require your participation.

Category:

Lyme, research, Treatment

Avoiding Ticks & Lyme Disease: UPMC Susquehanna Medical Director of Infectious Diseases Provides Safety Tips

https://www.weny.com/story/42243624/avoiding-ticks-and-lyme-disease-upmc-susquehanna-medical-director-of-infectious-diseases-provides-safety-tips

Avoiding Ticks and Lyme Disease: UPMC Susquehanna Medical Director of Infectious Diseases Provides Safety Tips

Saturday, June 13th 2020, 12:28 AM EDT by Ryan Campbell
WILLIAMSPORT, P.A. (WENY) – As COVID-19 restrictions across the Twin Tiers continue to ease, many community members are getting back to enjoying the outdoors. However, the region will need to be aware of ticks and Lyme Disease as we move into prime tick season.
According to most recent statistics released by the CDC in 2018, Pennsylvania significantly led the country in confirmed Lyme Disease cases with 7,920. New York had the third most cases with 2,446. WENY News spoke with the Medical Director of Infectious Diseases at UPMC Susquehanna, Dr. Rutul Dalal, and he says this year, people may need to be extra cautious. (See link for article and video)
___________________
**Comment**
Ticks can absolutely walk around and navigate through wood chips.  In fact, wood chips and leaf litter make wonderful humid areas to protect ticks.  I’m not saying don’t use them, just be aware that they will not keep ticks out, but will rather serve as a barrier between riskier areas and non-risky areas but ALL areas are somewhat risky.

Category:

Lyme, Ticks

After Son’s Bout With Lyme Disease, Woman Invents New Tick Repellent

https://www.theweathernetwork.com/ca/news/article/after-sons-bout-with-lyme-disease-woman-invents-new-tick-repellent  News Video Here

After son’s bout with Lyme disease, woman invents new tick repellent

Nathan Coleman
Reporter, Atlantic Canada

Friday, June 12th 2020

The formula, called ‘Atlantick’, has been found to be 97.5 per cent effective.

It’s been four years now since Darian Wallet suddenly became unable to move his legs without severe pain in Mahone Bay, Nova Scotia. It lasted for months, forced him to use a walker, and worst of all, doctors couldn’t determine why. In his words: “It was terrible.”

His mother, Lisa Ali, thought it could be juvenile arthritis, but she pushed to get a test for Lyme disease and her suspicions were right: it was the result of a tick bite. Darian’s brother had it too.

“When you see your child because he’s in that much pain and you don’t know what’s going on, that really kind of wakes your system up and puts you in ‘oh my God, I have to do something about this’ mode,” she says.

(See link for article)

_____________________

For more:  https://madisonarealymesupportgroup.com/2019/04/12/tick-prevention-2019/

https://madisonarealymesupportgroup.com/2019/07/01/what-you-need-to-know-about-bug-sprays/

https://madisonarealymesupportgroup.com/2019/06/16/study-shows-effectiveness-of-factory-treated-permethrin-impregnated-clothing-works/

https://madisonarealymesupportgroup.com/2018/05/27/study-conforms-permethrin-causes-ticks-to-drop-off-clothing/

https://madisonarealymesupportgroup.com/2018/04/03/fire-good-news-for-tick-reduction/

https://madisonarealymesupportgroup.com/2018/09/15/talking-tick-prevention-ask-a-uw-veterinarian/

Category:

Lyme, Prevention, Ticks